Thanks to the Affordable Care Act, about 1.2 million fewer Florida residents were uninsured in 2017 than in 2013, the year before major provisions of the landmark federal health law went into effect.
While this represents remarkable progress, Florida's share of residents without coverage remains one of the highest in the nation. In Hillsborough County, 17.1 percent of adults between 19 and 64 are uninsured; the rate of adults without coverage in Pinellas County is only slightly lower at 16.8 percent. This includes hard-working parents, people with disabilities and residents without children. (The latter group, it's worth noting, are unable to qualify for Medicaid at any income level.) Many make up the state's "coverage gap," the hundreds of thousands of Floridians with income too high to qualify for Medicaid under the state's extremely low threshold, yet too low to access federal marketplace subsidies.
Thirty-six states have chosen to expand their Medicaid program to adults with income up to 138 percent of the federal poverty level, or $29,435 for parents in a three-person household. These states have seen numerous positive outcomes — healthier mothers and babies, for example, and access to life-saving treatments for heart disease and cancer.
Lesser known are the fiscal benefits. A new report from the nonpartisan Florida Policy Institute estimates that the state would see about $200 million in savings by expanding the program to more than 800,000 low-income residents.
Expansion is cost effective, in short, because Florida is already spending money on Medicaid and other indigent health care programs. But unlike states that have opted to increase access to affordable health care through expansion, we aren't seeing federal tax dollars flowing back in our direction. The Sunshine State receives a 61 percent federal match rate for state dollars spent on Medicaid. Expansion would enable Florida to access a 90 percent match rate under the Affordable Care Act, meaning that $9 in federal money would match every $1 the state invests in Medicaid. Every year, nearly $4 billion in new federal money would return to Florida.
Michigan, as noted in the institute's report, expanded its Medicaid program in 2016 and has already replaced more than 1 billion in state dollars with federal funds for mental health and other state-funded programs. Expected savings for the state are pegged at $235 million, annually. Louisiana estimates it will save $313 million in fiscal year 2019, replacing state dollars spent on services for the uninsured and inmate hospitalizations with federal funds.
Florida policymakers on both sides of the aisle and at every rung of government have rightly stressed the urgency of addressing current health crises, including the opioid epidemic and skyrocketing unmet mental health needs. Increasing access to affordable health care coverage through a mechanism that's already in place, and one that's achieving better health outcomes and state savings, is just common sense.
Anne Swerlick is a senior policy analyst and attorney at the nonpartisan Florida Policy Institute.